In recent years, illegal acts such as impersonating doctors, reselling drugs and forging bills have seriously disrupted the order of medical safety management and endangered the vital interests of the broad masses of the people, and have been severely punished according to the law and regulations.
Case 1: Forging reimbursement materials to defraud insurance money
On 20021May 1 1 day, a city medical insurance bureau received a clue that Sun Mou, an insured transferred by a district medical insurance bureau, was suspected of forging or altering manual reimbursement materials to defraud the medical insurance fund. The Municipal Medical Insurance Bureau immediately filed a case and investigated the persons involved.
Upon verification, from 200211to 20021may, sun forged or altered the manual reimbursement materials to defraud the medical insurance fund 10 times, involving a total cost of 167295.3 1 yuan, which was actually paid by the medical insurance fund/
According to the Social Insurance Law of People's Republic of China (PRC), the Municipal Medical Insurance Bureau ordered Sun to return the defrauded medical insurance fund of RMB 14782.06, and imposed a fine of twice the defrauded amount. According to the provisions of the Criminal Law of People's Republic of China (PRC), Sun's behavior is suspected of constituting a crime, and he needs to be investigated for criminal responsibility according to law.
Case 2: prescribing drugs, reselling them with other people's medical insurance certificates, and fabricating illness.
In 20021year, Li (who is not an insured person in this city) prescribed drugs in a number of designated medical institutions with medical insurance certificates of five people, including family members and friends, on the grounds of fictitious illness, each time worth 1000 yuan, and then sold them to drug dealers at a price around 500 yuan, and prescribed drugs about four times a month. After verification, Li * * * defrauded the medical insurance fund of 79,632.64 yuan.
According to the Criminal Law of People's Republic of China (PRC), the people's court of our district made a judgment in accordance with the law, and Li was convicted of fraud, sentenced to fixed-term imprisonment of 1 year for 6 months, fined 20,000 yuan, and returned the illegal expenses of 79,632.64 yuan. The district medical insurance bureau will stop issuing cards to the insured involved in the loan medical guarantee.
Case 3: lease my doctor's guarantee to others for use.
In August, 20021year, the medical insurance department of a city received a report, which reflected that Zhao had rented the medical guarantee to others for use and was suspected of defrauding the medical insurance fund. The Municipal Medical Insurance Bureau immediately investigated the people involved and found that Zhao rented his medical insurance to others, allowing others to use his own name to seek medical treatment and prescribe medicine. Before the medical insurance department filed an investigation, the designated medical institutions voluntarily returned the illegal expenses 1306 yuan.
According to the Administrative Punishment Law of the People's Republic of China and the Regulations on the Supervision and Administration of the Use of Medical Insurance Funds, in view of the minor circumstances of this case, the Municipal Medical Insurance Bureau ordered Zhao to correct the illegal act according to law and made a decision not to impose administrative punishment on Zhao.
Case 4: Using family members' medical insurance vouchers to cheat for medical treatment.
On 20021April 13, a city's medical insurance bureau received a real-name report clue, reflecting that the insured Zhang had used other people's medical insurance vouchers for a long time to seek medical treatment. The Municipal Medical Insurance Bureau immediately filed a case against the persons involved. After verification, Zhang admitted that he used his family's medical insurance certificate to prescribe medicine and treatment in the outpatient department during the period from 20 19 to 202 1, resulting in the loss of medical insurance fund 14637.52 yuan.
During the handling of the case, Zhang actively cooperated with the investigation, truthfully stated the illegal facts and voluntarily returned the medical insurance fund 14637.52 yuan. Since the case occurred within the family and did not cause social impact, the Municipal Medical Insurance Bureau decided not to impose administrative punishment.
Case 5: Use your medical insurance certificate to prescribe medicine for your family.
In June 2022, 65438+ 10/0, a district medical insurance bureau received a report, reflecting
Du Mou, the insured, used his medical insurance certificate for a long time and prescribed drugs for his family to treat chronic diseases such as hypertension and diabetes in his own name.
Upon verification, Du Mou's behavior * * * caused losses to the medical insurance fund 1338+0 yuan.
The Medical Insurance Bureau of this district dealt with Du's behavior according to law and recovered the illegal expenses 1338+0 yuan.
Case 6: Empty medical insurance voucher
A city's medical insurance bureau received a report that the leader of a unit took the medical insurance vouchers of its employees from July to June, 2020, and offset the non-medical insurance expenses with blank medical insurance vouchers.
The Medical Insurance Bureau of this Municipality recovered the illegal expenses of 6987.438+0 yuan, educated a certain person, and locked the cards of the relevant persons involved. The hospital involved was interviewed and rectified within a time limit.